Becoming Whole Again

Post Mastectomy Reconstruction
Losing a breast to cancer is a traumatizing event for every woman – and each woman deals with it in her own way. For many women, reconstructive surgery to replace the breast is an important part of the healing process and options for reconstruction should be considered at the same time that the mastectomy is planned. For insurance purposes, breast reconstruction is considered part of the treatment plan for those who choose it, and is covered in the same way that other breast cancer treatments are.

There are two general categories of reconstruction after mastectomy; one uses tissue from another part of the body, such as the tummy, to replace the breast tissue, and the other uses an implant placed behind the chest muscle to rebuild the breast mound. Both have their particular benefits and downsides, and some women are candidates for one approach and not the other. In addition, the need for post mastectomy radiation can affect which type of reconstruction will give the best results. For this reason, your surgeon will work closely with you and a Plastic Surgeon in helping you decide which type of reconstruction is right for you.

In general terms, the tissue transfer techniques give a very natural look and feel to the new breast – after all, it is still all you. And when the tissue is transferred from the tummy as in the TRAM (“Transverse Rectus Abdominus Myocutaneous”) flap, the woman gets a flatter tummy in addition to a new breast. The recovery from this operation is longer than that for implant reconstruction, and there can be some abdominal weakness that a very active woman might find unacceptable.

An implant reconstruction uses a saline implant to replace the breast mound. This type of reconstruction is achieved in two stages beginning with placement of a tissue expander behind the chest wall muscle at the time of the mastectomy. Then, over the next several weeks, the tissue expander is inflated with water injected through a special port until the desired breast size is reached. The tissue expander is then exchanged for the formal saline implant in a separate operation.

Using either technique, a nipple can be reconstructed after the breast has completely healed, and often a simple procedure to “lift” the opposite breast so that it matches the new one is performed for optimum cosmetic results. If a woman cannot decide whether she wants reconstruction at the time of the mastectomy or which kind she wants, either technique can be used at a later date when she is more prepared to make those choices.

Copyright 2008 by Janet Grange, MD